Form Centre

1. I/We hereby authorize the Town of Cochrane and its Financial Institution to debit my/our account listed above for monthly utility charges (i.e. water, sewer, refuse, recycling) payable to the Town of Cochrane in the amount of the monthly utility invoice amount.
2. A sample cheque marked "VOID" is attached to this authorization.
3. Any payments returned N.S.F. or because of a closed account may result in termination of the Debit Plan; and all outstanding utilities become due and payable and subject to penalties. A $30.00 service charge will be levied on all returned payments.
4. This authorization may be cancelled at any time upon two (2) weeks written notice, and any outstanding utility charges become due and payable and subject to penalties.
5. In the event of a sale of the above noted property or a change in bank accounts, I/We will notify the Town of Cochrane in writing at least two (2) weeks prior to the next due date to arrange for cancellation or provide the new bank account information and a cheque marked "VOID".

I, being the owner of the property identified here, certify that all the information on this application is true. I realize that failure to comply with the regulations and conditions set out in the Town of Cochrane Water Utility Bylaw can and will result in enforcement action against me.